About this blog.

My son was diagnosed with PDD-NOS at 24 months. I created this blog to bring meaning to the often-confusing label. Sometimes I have answers. Other times, just more questions.

Thursday, March 12, 2009

Mind/Body Connection

There's a school of thought that what Brad has is, and should be treated as, primarily a language disorder. I haven't blogged much, if at all, about speech therapy and communication issues. The reason: I regard Brad's speech delay as a symptom of something else. Of course I've blogged about that "other thing," whatever it is, ad nauseum.

But some one could probably present a similar case for the motor symptoms. That is, one might similarly argue that the motor impairments and hypotonia are just a symptom of something else, so why focus on those discrete symptoms?

Two thoughts on this:

1) I don't regard DCD as an isolated motor deficit. While the DSM-IV description of DCD points in that direction, in common parlance the alternate term "dyspraxia" is understood to engender a whole host of traits from speech delay to social impairment to disorganization of thought. And as I blogged, DCD is a set which overlaps with autistic spectrum disorders.

2) I've observed many therapy sessions, including speech, occupational therapy, developmental therapy and floortime. Hands down, without question, the most effective sessions by far have been the occupational therapy sessions. The occupational therapist, not the speech therapist, gets the most spontaneous speech from him. While I don't have proof of its effectiveness in a clinical sense, this mama believes that occupational therapy implicates some kind of mind/body connection.

Because the occupational therapy (OT) visits were so successful, the developmental therapist(DT) did a co-visit so that she could observe the OT's technique, and carry it over in her own sessions. And lo and behold it made all of the difference. For example, at first the developmental therapist would sit on the floor with Brad and play with him, and try to get him out of rigid routines, and to use imagination, etc. It just didn't work. I mean they played, but Brad mostly phoned it in, and veered into his comfort zone, i.e. blocks. After the co-visit, she started interjecting movement breaks into the play. It was simple: she put the wooden puzzle pieces on one side of the room and the puzzle on another. Voila! Such a small thing made such a big difference.

Brad's occupational therapist explained that it's tied to his arousal level. As I blogged, Brad presents as a sensory disregarder - "ho hum", difficult to stimulate and unmotivated to move. If Brad were a car, his idle would be on low. Seriously, by my count, he's had less than five full blown tantrums in his entire life and he's never had what can be described as a "meltdown." As I've blogged before, he has never once stood up in his crib, without prompting and assistance.

Brad's occupational therapist showed me that getting him to move increases his arousal level. And, in turn, when his arousal level is higher, so too is his level of engagement and spontaneous speech. So to make a long story long, this is why I don't blog about speech therapy. I regard the speech as intrinsically tied to sensory processing and arousal. To blog about communication without the other stuff doesn't make sense. To me, anyway.

Ever wonder why autism diagnosis shows a positive correlation to rainfall? I have a theory: these kids aren't outside much and therefore aren't moving enough. Moving the body forces the left and right hemispheres of the brain to talk to each other, which, in turn, promotes healthy neurological development in all respects. Just sayin. It's possible.


Anonymous said...

Very interesting.

I haven't seen the same connection with Charlotte. Moving about doesn't make her more communicative, although I do believe she falls in the low arousal end of the camp too.

Hopefully school recognizes this and provides plenty of movement opportunity for Brad.

A little boy just 2 years old said...

We are HIGH arousal with an engine NEVER idleling - he can't STOP moving. So, if we go with this theory.... maybe we get the best results if we put the puzzle and pieces as close together as possible. LOL. I'm so kidding - but I LOVE the thought process here.

I'm trying to turn it all around in my head re:DS to understand what that would mean for us if you are on to something....

And I'm going to stick my tongue out at you for getting such a GREAT OT!!! It seems we might be in a better boat now, but I have always felt that OT could come or go - eh.

Oh yeah. I was going to say - that SLP has been our most improved therapy - in which he is sitting still and attentive... hmmmmmm

Laura said...

I think it has to do with lateralization (of the brain). And I think our kids are similar in terms of symptom severity, but maybe different in terms of quality of symptoms or underlying etiology? There are objective ways of measuring things like visual integration, procieptive sense and motor function, and studies have shown that, at least with respect to DCD, there is huge variation in perceptual and processing abilities. That is, even within DCD, the nature of the impairment is highly variable. And perhaps that's why no two "atypical" kids are the same.

Patience said...

Have your ever read "Building Bridges through Sensory Integration" or "The out of sync Child"? The first is a bit more for Ot's but the second is really readable about how OT can address different deficits in communication, coordination and other sensory problems. My oldest boy could have been the twin of the boy in the book described as "all talk and no action"
Also I was going to mention therapuetic horse back riding as something we tried (dd enjoyed it anyway but others swear by it) as another balance/communication/coordination therapy.

Anonymous said...

While Rhema is not on the low arousal end (-she never stops moving), we definitely get the best eye contact/interaction from her during *structured* movement and physical play. They key has always been to interrupt her movement and then require a request or eye contact for "more." For e.g., bouncing her on a exercise ball while singing a song, then stopping and waiting for some form of communication from her before continuing. The eye contact from her is amazing during this type of play. Totally supports the mind/body connection theory.

I think I've commented here before that I often laugh at myself for thinking, in the beginning, that Rhema did not need OT. It has proven to be one of the most successful treatments for her by far. And, unlike Brad, I think it is BECAUSE she loves/needs to move.

Interesting, huh?

Laura said...

Patience, thanks, yeah I've read (and committed to memory!) Out of Sync - great resource. Hippotherapy intrigues, but at this point, I think we're going to try to get him more into swimming (as natural exercise doubling as therapy). He loves the water!

jeneil, too true. Studies have shown the same, ie improved eye contact correlates to swing.

LT-Mommy said...

I treat my child for his communication disorder through an OT. This is mostly from a series of bad experiences with SLPs. I think that you do what is appropriate for your child, and sometimes I think we're extremely foolish to think these areas should be treated different as if they're seperated. I will say, my oldest is finally really starting to connect with his SLP and making progress with her. But this is his 4th or 5th one. And the first he's connected to. There's something to be said about reaching a child on a child's level, which isn't doable if you have your own agenda in mind. My youngest is only seen by an OT now, and he adores her and I swear holds out on things just to show her.

Laura said...

LT-Mommy - Different paths, similar destination, huh. I think most of us just gravitate to what works for our children. We're not even doing private speech, even though my husband's insurance would cover it. He gets two 1/2 hour one on one sessions at school - I think that's enough.

Julie said...

Sometimes an OT can be your best friend:-) Made all the difference in the world for my son!!! Knowing how and when to incorporate movement (or calming activities) can make the kids more available to absorbing whatever else they need to work on. I can't tell you how many kids that I used to see who would only make eye contact or vocalize when bouncing on a ball or swinging.

And the "Building Bridges" book is one of my favorites. There were lots of activity suggestions and even reproducible handouts in the back. I lent it out to someone a couple of years ago and never got it back... Try the library for that one. I think I remember it was at least $30.

Bottom line, which you are all figuring out, is to watch the sessions to see what works for your kid. And of course, to notice what YOU do that works. A good clinician should never be offended if you say something like "I noticed that he responds really well when I've done ----."

Keep up the good work!!!

Laura said...

Thanks for the note Julie. Now I have two recs for Building Bridges so I might have to get that one, esp if it has nifty exercises.